Provider Demographics
NPI:1730156209
Name:COMPO, RENEE B (WHNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:B
Last Name:COMPO
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:B
Other - Last Name:COMPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:952-595-6455
Practice Address - Street 1:5100 GAMBLE DR SUITE 100
Practice Address - Street 2:MAIL STOP 31200A HEALTH PARTNERS WEST CLINIC
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1582
Practice Address - Country:US
Practice Address - Phone:952-541-2500
Practice Address - Fax:952-595-6455
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0635226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN989740200Medicaid
MN500001241Medicare ID - Type Unspecified
MN989740200Medicaid